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CC BY-NC-ND 4.0 · Indian J Plast Surg 2012; 45(02): 352-363
DOI: 10.4103/0970-0358.101318
Review Article
Association of Plastic Surgeons of India

The management of perineal wounds

Atul Parashar
Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Ramesh K. Sharma
Department of Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations
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Publication History

Publication Date:
27 November 2019 (online)

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ABSTRACT

Management of perineal wounds can be very frustrating as these invariably get contaminated from the ano-genital tracts. Moreover, the apparent skin defect may be associated with a significant three dimensional dead space in the pelvic region. Such wounds are likely to become chronic and recalcitrant if appropriate wound management is not instituted in a timely manner. These wounds usually result after tumor excision, following trauma or as a result of infective pathologies like hideradenitis suppurativa or following thermal burns. Many options are available for management of perineal wounds and these have been discussed with illustrative case examples. A review of literature has been done for listing commonly instituted options for management of the wounds in perineum.

KEY WORDS

Muscle fl aps - perforator fl aps - perineum - reconstructive options - skin grafts - vacuum assisted closure
 
  • 1 http://www.merriam-webster.com/dictionary/perineum, visited on 18 04 2012 at 7pm
  • 2 McAllister E, Wells K, Chaet M, Norman J, Cruse W. Perineal reconstruction after surgical extirpation of pelvic malignancies using the transpelvic transverse rectus abdominus musculocutaneous flap. Ann Surg Oncol 1994;1:164-8.
  • 3 Yeh KA, Hoffman JP, Kusiak JE, Litwin S, Sigurdson ER, Eisenberg BL. Reconstruction with musculocutaneous flaps following resection of locally recurrent rectal cancer. Am Surg 1995;61:581-9.
  • 4 Touran T, Frost DB, O′Connell TX. Sacral resection: Operative technique and outcome. Arch Surg 1990;125:911-3.
  • 5 McCraw JB, Massey FM, Shanklin KD, Horton CE. Vaginal reconstruction with gracilis musculocutaneous flaps. Plast Reconstr Surg 1976;58:176-83.
  • 6 Wiatrek RL, Thomas JS, Papaconstantinou HT. Perineal wound complications after abdominoperineal resection. Clin Col Rect Surg 2008;21:76-85.
  • 7 Park JJ, Del Pino A, Orsay CP, Nelson RL, Pearl RK, Cintron JR, et al. Stoma complications: The Cook County Hospital experience. Dis Colon Rectum 1999;42:1575-80.
  • 8 Bordes J, Goutorbe P, Asencio Y, Meaudre E, Dantzer E. A non-surgical device for faecal diversion in the management of perineal burns. Burns 2008;34:840-4.
  • 9 Artioukh DY, Smith RA, Gokul K. Risk factors for impaired healing of the perineal wound after abdominoperineal resection of rectum for carcinoma. Colorectal Dis 2006;9:362-7.
  • 10 Stone HB, Coleman CN, Anscher MS, McBride WH. Effects of radiation on normal tissue: Consequences and mechanisms. Lancet Oncol 2003;4:529-36.
  • 11 Christian CK, Kwaan MR, Betensky RA, Breen EM, Zinner MJ, Bleday R. Risk factors for perineal wound complications following abdominoperineal resection. Dis Colon Rectum 2005;48:43-8.
  • 12 Niranjan NS. Perforator flaps for perineal reconstructions. Semin Plast Surg 2006;20:133-44.
  • 13 Shibata D, Hyland W, Busse P, Kim HK, Sentovich SM, Steele G Jr, et al. Immediate reconstruction of the perineal wound with gracilis muscle flaps following abdominoperineal resection and intraoperative radiation therapy for recurrent carcinoma of the rectum. Ann Surg Oncol 1999;6:33-7.
  • 14 Tei TM, Stolzeburg T, Buntzen S, Laurberg S, Kjeldsen H. Use of transpelvic rectus abdominis musculocutaneous flap for anal cancer salvage surgery. Br J Surg 2003;90:575-80.
  • 15 Bakx R, Van Lanschot JJB, Zoetmulder FAN. Inferiorly based rectus abdominis myocutaneous flaps in surgical oncology: Indications, technique, and experience in 37 patients. J Surg Oncol 2004;85:93-7.
  • 16 Kapoor V, Cole J, Isik FF, Sinanan M, Flum D. Does the use of a flap during abdominoperineal resection decrease pelvic wound morbidity? Am Surg 2005;71:117-22.
  • 17 Buchel EW, Finical S, Johnson C. Pelvic reconstruction using vertical rectus abdominis musculocutaneous flaps. Ann Plast Surg 2004;52:22-6.
  • 18 Woods JE, Beart RW Jr. Reconstruction of nonhealing perineal wounds with gracilis muscle flaps. Ann Plast Surg 1983;11:513-6.
  • 19 Bartholdson L, Hulten L. Repair of persistent perineal sinuses by means of a pedicle flap of musculus gracilis. Case report. Scand J Plast Reconstr Surg 1975;9:74-6.
  • 20 Baek SM, Greenstein A, McElhinney AJ, Aufses AH Jr. The gracilis myocutaneous flap for persistent perineal sinus after proctocolectomy. Surg Gynecol Obstet 1981;153:713-6.
  • 21 Sharma RK, Biswas G. Repair of a urethral fistula following electrical burns using a gracilis muscle flap. Burns 1990;16:467-70.
  • 22 Bell SW, Dehni N, Chaouat M, Lifante JC, Parc R, Tiret E.. Primary rectus abdominis myocutaneous flap for repair of perineal and vaginal defects after extended abdominoperineal resection. Br J Surg 2005;92:482-6.
  • 23 Hui K, Zhang F, Pickus E, Rodriguez LF, Teng N, Lineaweaver WC. Modification of the vertical rectus abdominis musculocutaneous (VRAM) flap for functional reconstruction of complex vulvoperineal defects. Ann Plast Surg 2003;51:556-60.
  • 24 Sunesen KG, Buntzen S, Tei T, Lindegaard JC, Norgaard M, Laurberg S. Perineal healing and survival after anal cancer salvage surgery: 10-year experience with primary perineal reconstruction using the vertical rectus abdominis myocutaneous (VRAM) flap. Ann Surg Oncol 2009;16:68-77.
  • 25 Hurwitz DJ, Walton RL. Closure of chronic wounds of the perineal and sacral regions using the gluteal thigh flap. Ann Plast Surg 1982;8:375-86.
  • 26 Gould WL, Montero N, Cukic J, Hagerty RC, Hester TR. The "split" gluteus maximus musculocutaneous flap. Plast Reconstr Surg 1994;93:330-6.
  • 27 Sharma RK. Split gluteus maximus island flaps for concomitant closure of ischial and sacral pressure sores. Ann Plast Surg 2001;46:52-4.
  • 28 Benito P, De Juan A, Cano M, Elena E. Reconstruction of an extensive perineal defect using two modified V-Y flaps based on perforators from the gluteus maximus muscle. J Plast Reconstr Aesthet Surg 2008;61:e1-4.
  • 29 Blondeel PN, Van Landuyt K, Hamdi M, Monstrey SJ. Soft tissue reconstruction with the superior gluteal artery perforator flap. Clin Plast Surg 2003;30:371-82.
  • 30 Arnold PB, Lahr CJ, Mitchell ME, Griffith JL, Salloum N, Walker MR, et al. Predictable Closure of the Abdominoperineal Resection Defect: A Novel Two-Team Approach. J Am Coll Surg 2012;214:726-32.
  • 31 Metz BJ, Rubenstein MC, Levy ML, Metry DW. Response of ulcerated perineal hemangiomas of infancy to becaplermin gel, a recombinant human platelet-derived growth factor. Arch Dermatol 2004;140:867-70.
  • 32 Hom DB, Manivel JC. Promoting healing with recombinant human platelet-derived growth factor-BB in a previously irradiated problem wound. Laryngoscope 2003;113:1566-71.
  • 33 Papaconstantinou HT, Bullard KM, Rothenberger DA, Madoff RD. Salvage abdominoperineal resection after failed Nigro protocol: Modest success, major morbidity. Colorectal Dis 2006;8:124-129.
  • 34 Opelka FG. Unhealed perineal wound. Clin Colon Rectal Surg 2001;14:65-8.
  • 35 Ramakant SA, Bhattacharya S, Sinha KN, Dubey PC. Silastic foam elastomer for dressing open granulating wounds-a preliminary report. Indian J Plast Surg 1987;20:56-60.
  • 36 Wood RAB, Williams RHP, Hughes LE. Foam elastomer dressing in the management of open granulating wounds: Experience with 250 patients. Br J Surg 1977;64:554-7.
  • 37 Morpurgo E, Galandiuk S. Fournier′s gangrene. Surg Clin North Am 2002;82:1213-24.
  • 38 Eke N. Fournier′s gangrene: A review of 1726 cases. Br J Surg 2000;87: 718-28.
  • 39 Ozturk E, Ozguc H, Yilmazlar T. The use of vacuum assisted closure therapy in the management of Fournier′s gangrene. Am J Surg 2009;197:660-5.
  • 40 Czymek R, Schmidt A, Eckmann C, Bouchard R, Wulff B, Laubert T, et al. Fournier′s gangrene: Vacuum-assisted closure versus conventional dressings Am J Surg 2009;197:168-76.
  • 41 Sinna R, Qassemyar Q, Benhaim T, Lauzanne P, Sabbagh C, Regimbeau JM, et al. Perforator flaps: A new option in perineal reconstruction. J Plast Reconstr Aesthet Surg 2010;63:e766-74.
  • 42 Wang TN, Whetzel T, Mathes SJ, Vasconez LO. A fasciocutaneous flap for vaginal and perineal reconstruction. Plast Reconstr Surg 1987;80:95-102.
  • 43 Wee JT, Joseph VT. A new technique of vaginal reconstruction using neurovascular pudendal thigh flaps: A preliminary report. Plast Reconstr Surg 1989;83:701-19.
  • 44 Woods JE, Alter G, Meland B, Podratz K. Experience with vaginal reconstruction utilising the modified Singapore flap. Plast Reconstr Surg 1992;90:95-102.
  • 45 Spear S, Pellegrino CJ, Attinger CE, Potkul RK. Vulvar reconstruction using a mons pubis flap. Ann Plast Surg 1994;32:602-5.
  • 46 Bertani A, Riccio M, Belligolli A. Vulval reconstruction after cancer excision: The island groin flap technique. Br J Plast Surg 1990;43:159-61.
  • 47 Yii NW, Niranjan NS. Lotus petal flaps in vulvo-vaginal reconstruction. Br J Plast Surg 1996;49:547-54.